The Insuring Agreement

Eligibility

1. You are a Canadian Resident.
2. You have not yet reached Your 76th birthday at the time of Application.
3. You are insured under the government health care plan of the province or territory in which You reside.
4. The information provided by You at the time of Application is true and accurate.
5. The expenses You incur result from an Acute, sudden and unexpected Emergency.
6. The Emergency first occurs and the Medical Treatment is provided outside Your province or territory of ordinary residence.

Period of Coverage

1. If purchased after the date of departure from Your province or territory of ordinary residence; or,
2. If the application date is after the date of departure from Your province or territory of ordinary residence; or,
3. If purchased for a trip not originating in Canada.

The Insurance Benefits

Eligible Medical Expenses

1. Hospital Confinement and Treatment
   1. Hospitalization (limited to semi-private accommodation) due to a medical Emergency. In the case of Hospital confinement, any coverage related to the Hospital confinement terminates upon release from Hospital.
   2. The services of a Licensed Medical Physician.
   3. The services of a licensed ambulance, including mountain and sea rescue, from the scene of the accident or place of onset of the Sickness to the nearest Hospital.
   4. X-ray examinations and diagnostic laboratory procedures when performed at time of Emergency.
   5. Medicines and/or drugs (excluding vitamins, minerals, dietary supplements and patent medicines) prescribed by the attending Physician for a maximum period of 30 days. While the Insured Person is confined to Hospital, the Company will reimburse the total cost of such medicines and/or drugs.
   6. Rental of essential medical appliances including but not limited to wheelchairs: crutches and canes, but in no event will the rental amount payable exceed the total purchase price.
   7. Private-duty nursing services, in lieu of hospitalization, performed by a registered nurse (R.N.) when ordered in writing by the attending Licensed Medical Physician. The maximum amount reimbursable by the Company in respect of this expense is limited to $3,000 per covered trip.
2. Other Professional Medical Services
   When deemed essential by the attending Physician, and when the Medical Treatment has been administered for relief of Acute Emergency pain caused by an accidental Injury, expenses for:
   1. physiotherapy or chiropractic benefits to a limit of $300,
   2. services of a licensed chiropodist, osteopath or podiatrist to a limit of $300. Chiropractic benefits are limited to the initial office visit and treatment.
3. Dental Services
   Benefits are payable to a maximum limit of $3,000 per covered trip for an accidental blow to the face requiring the repair or replacement of whole or sound natural teeth. Also, benefits are payable for other Emergency treatment for pain relief, other than a blow to the face, up to a maximum limit of $300. All dental treatment must be initiated within 48 hours from the time the Emergency began and completed no later than 90 days after the treatment has begun.
4. Emergency Air Transportation
   At the discretion of the Company and coordinated and arranged by OneWorld Assist Inc., medical transport (by the most appropriate means, stretcher accommodation or Emergency air ambulance service if the condition of the Insured Person prevents the use of other means of transportation) to the nearest medical facility equipped to provide the required treatment, or for return to Canada, including any necessary medical accompaniment; also included will be the cost to return the Insured's travelling companion aboard the medical transport or when space does not permit aboard the medical transport, up to $1,000 for a one-way economy airfare.
5. Out-of-Pocket Expenses
   The Company will reimburse up to $150 per day to a maximum of $1,000 (receipts required) per covered trip in the event an Insured or travelling companion is confined to Hospital on the date on which he or she is scheduled to return to Canada for reasonable and necessary accommodation, meals, telephone calls, taxi or bus fare and child care costs (excluding child care provided by a parent or legal guardian) for dependents up to the age of 18 years.
6. Family Transportation Expense If an attending Physician considers it necessary, the Company will reimburse one economy return airfare or other transportation costs up to a maximum limit of $1,000 to enable Your spouse, son, daughter, parent, brother, sister or significant other, to be with You while You are in Hospital, and up to a maximum of $100 per day for meals and accommodation. This benefit is payable only if the expense has been coordinated, arranged and approved in advance by OneWorld Assist Inc.
7. Repatriation Expense
   In the event of Your death, the Company will reimburse the following:
   1. The cost of preparations for burial and transport of the body to Your province or territory of ordinary residence. The maximum amount reimbursable in respect of this expense is limited to $3,000.
   2. The cost for cremation or burial at the place of death in the event the body is not returned to Your province or territory of ordinary residence. The maximum amount reimbursable in respect of this expense is limited to $2,000.
8. Return of: a) Vehicle, b) Insured to U.S.A., c) Airfare Home
   1. If the attending Physician determines that as a result of Emergency Sickness or Injury, You are incapable of continuing Your trip by means of the Vehicle used for the trip and Your travelling companion is unable to do so for You, the Company will reimburse the actual reasonable and necessary charges for a commercial agency to return a Vehicle that You own or rent to either Your home or the nearest appropriate vehicle rental agency. The maximum benefit payable is limited to the amount it would cost the Company to return Your Vehicle, but in no event will the maximum benefit payable exceed $2,000.
   2. If by virtue of Emergency air evacuation, which was arranged and coordinated by OneWorld Assist Inc. in order to obtain medical care in Canada, the Insured wishes to return to his destination in the U.S.A., the Company will pay the costs of a one-way economy airfare to the city from where the air evacuation commenced. This benefit is in lieu of the Return of Vehicle benefit as above. It is only available to those persons who have been air evacuated under the terms and conditions of this Policy and can only be offered once during the same covered trip and cannot exceed Your original expected return. The air evacuation occasioning this benefit cannot originate within Canada.
   3. If, in the event of a medical Emergency, the Insured elects to return to Canada for treatment saving the Insurer the cost of Medical Treatment in the U.S.A., the Company will reimburse the cost of a one-way economy airfare home, by the most direct route, for the Insured and one travelling companion to a maximum of $2,000. Documentation is required to validate claim. This benefit is in lieu of a) and b) above.
9. Escort of Insured Children
   In the event an Insured Person has been air evacuated to Canada for medical reasons, the Company will pay the economy class airfare to return an accompanying Insured child/children(up to the age of 15 years) to the original point of departure. The Company will also pay for an escort to accompany the children when necessary. This benefit is payable only when approved and arranged by OneWorld Assist Inc.

Exclusions

1. The first $250 USD of the eligible expenses per Insured Person, per covered claim unless You have paid the zero deductible surcharge at the time of Application. This Exclusion applies to the portion of eligible expenses remaining after payment by Your provincial government health care plan or other insurance policies, plans or contracts, including any private or provincial automobile insurance.
2. Any Pre-existing Condition as defined, except for persons 55 years and under for any condition which has remained Stable in the 180 days prior to the commencement date of a covered trip.
3. Any condition(s) for which the Insured is registered on a Canadian hospital list waiting to receive treatment.
4. Elective (non-emergency) Treatment or Surgery.
5. Any Medical Treatment which is a continuation of, or subsequent to an Emergency Sickness or Injury, unless You are declared medically unfit to return to Your province or territory of ordinary residence.
6. Any subsequent claim of the same medical condition with respect to a Sickness or Injury which occurred during the effective term if this insurance, and for which a claim has been made or is pending.
7. A trip that is undertaken:
   1. against Physician's advice; or
   2. after diagnosis of a Terminal Condition.
8. Any condition or recognized complication of a condition, where the purpose of Your trip is to seek Medical Treatment or advice for that condition, and where it can be reasonably shown that the Medical Treatment received is related to that condition.
9. Expenses incurred as a result of the Insured's failure to accept or follow the Physician's advice, treatment or recommended treatment.
10. A medical condition for which treatment or hospitalization could have reasonably been expected.
11. Conditions or any related conditions for which, prior to departure, tests and investigative consultation took place, were scheduled to take place or were recommended, and for which results had not yet been received at the time of departure. This includes tests that were recommended or scheduled prior to departure, but had not taken place at the time of departure.
12. Tests and investigative consultation including, but not limited to biopsies, except when performed at the time of initial Emergency Sickness or Injury.
13. Routine pre-natal care, a child born during your trip, pregnancy, complications thereof, childbirth or complications thereof, occurring within the last 9 weeks immediately before or after the expected date of delivery or where the Insured Person is travelling against Physician's advice.
14. Air ambulance unless arranged and pre-approved by the Company.
15. Expenses incurred after Emergency Air Transportation, when the Emergency Air Transportation was not coordinated and arranged by OneWorld Assist Inc.
16. 1. War, civil war, riot, rebellion, insurrection, revolution, invasion, hostilities or warlike operations (whether war be declared or undeclared), civil commotion, overthrow of the legally constituted government, military or usurped power, explosions of war weapons, utilization of nuclear, chemical or biological weapons;
    2. death or disablement in any way caused by or contributed by radioactive contamination; or
    3. any action taken in controlling, preventing or suppressing any, or all of a) or b) above.
17. Suicide, attempted suicide, or self-inflicted injury, or the commission or attempted commission of any criminal/criminal-like act by the Insured, an immediate family member or a travelling companion.
18. Psychotherapeutic treatment or rehabilitative treatment, psychological, mental or emotional disorders.
19. Treatment, service or prescriptions required for ongoing care, check-ups, or provided in a psychiatric hospital, chronic unit of a general hospital, convalescent or nursing home, health spa, or rehabilitation centre.
20. Injury or Sickness while participating in Professional Sport activities, any motorized speed contests, hang-gliding, rock climbing, mountaineering, parachuting, skydiving and scuba diving unless You are certified by internationally recognized and accepted programs (NAUI, PADI).
21. The consumption or abuse of any alcohol, drugs or medication, or any event, act or omission caused or contributed to by the use or abuse of alcohol, drugs or medication.
22. Loss of or damage to eyeglasses, contact lenses, prosthetic devices, hearing aids.
23. A condition arising out of or resulting from Acquired Immune Deficiency Syndrome ("AIDS") or AIDS Related Complex ("ARC") if the condition first manifested itself prior to the Effective Date of Coverage or if the condition arose out of Acquired Human Immunodeficiency Virus ("HIV") which had first manifested itself prior to the Effective Date.
24. This Policy does not provide reimbursement for Eligible Medical Expenses once the Emergency ends and in the opinion of the attending Licensed Medical Physician or dentist You are able to travel home to Your province or territory of ordinary residence for all or part of treatment relating to that Emergency.
25. Coverage commencing after the departure date from Canada unless authorized by Travel Underwriters.
26. Treatment or services that contravene any provisions of any provincial government health care plan of the province or territory in which the Insured resides.
27. Expenses incurred if other insurance policies, plans or contracts, including any private or provincial automobile insurance, cover the loss. If however, the loss exceeds the limits of the other policies, plans or contracts in dollar or day value, this Insurance shall then apply in excess of all other valid insurance.

General Conditions

1. Qualification, Misrepresentation and Fraud - The coverage under this Policy shall be void if an Insured does not meet the eligibility requirements for the plan selected as set out in the Application. The eligibility requirements are material to the risk for which insurance is sought. In addition, the coverage under this Policy shall be void if, before or after a loss, the Insured or his or her representative misrepresents, conceals or fails to disclose any material fact or matter, or if there is any fraud or false swearing by the Insured or his or her representative, pertaining to the Insured or any claim under this Policy.
2. Subrogation - The Company will not subrogate against any employment plans if the lifetime maximum limit for all in-country and out-of-country benefits is $50,000 or less. If the Insured shall acquire any right of action against any person, firm or organization for loss covered hereunder, the Insured shall, if requested by the Company or Travel Underwriters or OneWorld Assist Inc. assign and transfer such claim or right of action to the Company and will permit suit to be brought in the Insured's name under the direction and expense of the Company. The Insured shall do nothing after loss to prejudice such rights.
3. Misstatement of Age - If the age of the Insured Person has been misstated to the Company the coverage and/or premium may be adjusted in accordance with the correct age as of the date You became covered. Any premium adjustment is payable upon receipt of a premium notice.
4. Due Diligence - You must act at all times so as to minimize the costs to the Company.
5. Currency - Any dollar expressed as a limit of coverage or benefit payable under this Policy is deemed by the Company to be in Canadian currency.
6. This Policy does not provide reimbursement for any eligible expenses if information provided at the time of application is not true and accurate.
7. The availability, quality, results or effects of any medical treatment assistance, hospitalization, transportation or failure of an Insured Person to obtain any of the above, is not the responsibility of either the Company or Travel Underwriters or any company or agency providing services on their behalf.
8. The Company reserves the right to accept or to decline any person as an Insured.
9. The Company reserves the right to limit the requested duration of coverage to whatever duration the premium paid would have purchased, if payment received is insufficient. If You paid insufficient premium, the duration of coverage will be decreased to the period that would have been provided for Your age category. Where no date of birth is provided, the highest premium for that trip length applies.
10. Extensions to the Insurance term can only be considered when the Company is contacted prior to Expiry Date. Any extension not authorized by Travel Underwriters will be considered void.
11. OneWorld Assist Inc. has been appointed by the Company to be the sole provider of all assistance and claims processing services.
12. In the event of medical treatment of an Insured Person or other circumstances that have led or may lead to a claim under this Policy, the Insured Person authorizes any Hospital, Physician or other person or organization that has records or knowledge of the Insured Person or his or her health, medical history or other information relevant to the claim to provide that information to the Company or OneWorld Assist Inc. and authorizes the Company and OneWorld Assist Inc. to use and disclose that information for the purpose of determining whether a claim that may be made is covered by this Policy or by another plan or Policy.
13. In the event of a claim, the Insured may be required to establish the date of departure and initially planned date of return of the trip in order to comply with the Terms of the Policy.
14. The Insured Person(s) shall be responsible for the verification of any Hospital and medical expenses incurred and shall obtain itemized accounts of all Hospital and medical services which have been provided.
15. The Insured claimant must be able to furnish, if required by the Company or Travel Underwriters or OneWorld Assist Inc., medical records for the period prior to the Effective Date of the Insurance. Failure to produce these records may invalidate claim.
16. The Company shall not be liable for any expense incurred after a period of 365 days has elapsed following the date on which the Emergency first occurred or commenced during the Period of Coverage.
17. The Company and OneWorld Assist Inc. shall comply with all applicable privacy legislation and regulations.
18. Terms of the Policy which are in conflict with the statutes of the province wherein this Policy is issued are hereby amended to conform to such statutes.
19. In the event of unresolved disputes respecting any claim or portion thereof, the following should be contacted: Travel Underwriters, 11th Floor, 6081 No. 3 Road, Richmond, BC V6Y 2B2.
20. The law of the province or territory of Canada in which You ordinarily reside will govern this Policy, including all issues of its interpretation and performance. Any legal action or other proceeding related to or connected with this Policy that is commenced by You or anyone claiming on Your behalf or by an assignee of benefits under this Policy must take place in the courts of that province or territory of Canada in which You purchased this Policy, and no other court has jurisdiction to hear or determine any such action or proceeding.

Automatic Extensions to Coverage

1. for 72 hours in the event a Delayed Common Carrier prevents You from returning to Your province or territory of ordinary residence; or,
2. if You are Hospitalized during the term of this Policy, for the period of Hospital confinement plus 72 hours after release for You to travel home.

Authorized Extensions to Period of Coverage

1. THE INSURED MUST CALL Travel Underwriters as close as possible to the Expiry Date and/or end of Period of Coverage to arrange for extension of the Policy. An extension fee will be charged to cover the administrative costs.
2. Extensions will not be issued or authorized if the Insured Person has seen a Physician since the departure date.
3. Extensions will not be issued or authorized if a claim has been made or it is known that a claim will be made.
4. Extensions will not be issued or authorized if the Policy or Period of Coverage has already expired.
5. Extensions are not available if total trip length exceeds 2 years from the Effective Date of the original Policy.

Refunds

Definitions

1. must be eligible for or has a provincial government health care plan in place; or
2. must be a Canadian citizen with a primary permanent residence in Canada; or
3. must have landed immigrant status with a primary residence in Canada.

1. not required for the immediate relief of Acute pain and suffering and which if not rendered would not result in an Insured Person being in continued danger; or,
2. which reasonably could be delayed until the Insured returns to Canada; or,
3. which the Insured elects to have provided during the insured trip following Emergency Medical Treatment of a medical condition or the diagnosis of a medical condition, which on medical evidence would not prevent the Insured from returning to Canada prior to such treatment or surgery.

1. the unchanged use of prescribed drugs or medication for a Stable condition, symptom or problem; or,
2. a check-up where the Physician observes no change in a previously noted condition, symptom or problem.

Statutory Conditions

1. the claimant must afford to the insurer an opportunity to examine the person of the person insured when and so often as it reasonably requires while the claim under this contract is pending, and
2. in the case of death of the person insured, the insurer may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies.

How to Claim

1. Any notices of claim or correspondence concerning a claim should be promptly sent to:
   OneWorld Assist Inc.
   11th Floor, 6081 No. 3 Road
   Richmond, BC Canada V6Y 2B2
2. Claim Forms will be provided to the claimant for completion and return to OneWorld Assist Inc. It is the responsibility of the claimant to complete and/or produce any documentation required by OneWorld Assist Inc. to enable them to process and confirm the eligibility of the claim.
3. Any cost incurred by OneWorld Assist Inc. in obtaining further documentation required to confirm eligibility of Your claim is also the responsibility of the claimant.
4. All required documentation must be received within one year from the date of loss. Failure to do so will result in the denial of the claim.
5. OneWorld Assist Inc. will submit a claim for medical expenses to Your provincial government health care plan offices PROVIDED THAT the Claim Form, as well as the appropriate Provincial Assignment Form are completed in full and forwarded together with receipts from legally qualified medical Physicians or Hospitals along with medical certificate(s) from attending Physician(s) within the time frame provided. The claim must be submitted to Your provincial government health care plan offices within 90 days from the date of service. If You fail to meet this timeline You will be responsible for the provincial government health care plan portion.
6. Claims will not be considered unless the Claim Form is completed in full and signed by the claimant. The Certificate of the Canadian Physician must be completed and returned to OneWorld Assist Inc. at their request. Failure to provide fully completed forms may invalidate Your claim.
7. Only bills from Physicians, Hospitals and other medical care providers which are original itemized and which state the Insured's name, diagnosis, date(s) of service and type of treatment or service will be considered. Only original pharmacy prescription receipts will be considered.